Clinical Claim Review RN - Work from home!

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work. (sm)   
Work at home from anywhere in the U.S! 
  
We are searching for an RN to join our Clinical Claim Review team!    
  Primary Responsibilities:



Reviews pre and post service claims for clinical eligibility for coverage as prescribed by the Plan benefits  

Reviews and interprets Plan language appropriately  

Utilizes clinical guidelines and criteria appropriately  

Responsible for accurately documenting determinations  

Adherence to all confidentiality regulations and agreements  

Must be able to work independently and in a team  

Must exhibit a high level of professionalism and integrity  

Effectively and professionally communicates with both internal and external customers/providers, following prescribed policies  

Serves as a resource to others

Required Qualifications: 

Undergraduate degree or equivalent experience
Current RN Licensure in good standing
Minimum five years of experience in a nursing clinical setting
Proficient computer and technical aptitude including experience with PC and MS Office including strong keyboarding skills
Demonstrated ability to work independently
Preferred Qualifications: 

Experience with MCG, utilization review and/or chart review
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)  
  
  
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. 
    
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. 
  

Job Keywords: RN, utilization Review, Concurrent Review, Telecommute